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THE WORLD ALLIANCE AGAINST ANTIBIOTIC RESISTANCE (WAAAR): A MAJOR PLAYER IN THE GLOBAL DRIVE TO PROTECT HUMAN HEALTH

Antibiotics are the most central part of post WWII modern health system as we know it.

Governments have been slow to respond even though all knowledgeable medical authorities know the dangeris mounting.

The ACdeBMR / WAAAR (World Alliance Against Antibiotic Resistance), not-for-profit NGO, was created on December 2nd, 2011 in Paris, France, by doctors and professors, most of whom had many years of activities in research, advocacy and practice on the threat of antibiotic resistance. President and founder Dr Jean Carlet was solicited to Chair and put together the National Task force For the Preservation of Antibiotics for the French government in 2015; he had been publishing, or speaking in medical congresses, over a 30 year period on antibiotic resistance, as another WAAAR founding member Pr Jacques Acar, member of the WHO Advisory Group on Integrated Surveillance of Antimicrobial Resistance (AGISAR) and of OIE (World Organization for Animal Health), him since 1972! WAAAR founders included prominent consumers and patients organizations as well. Now, in 2017 WAAAR is made up of 730 individual members from 55 different countries representing all the key stakeholders (physicians, veterinarians, microbiologists, pharmacists, nurses, evolutionary biologists, ecologists, environmentalists, and patient advocacy groups). WAAAR’s programs are endorsed by more than 140 learned societies or professional groups throughout the world.

The increase in antibiotic resistant bacteria poses a major healthcare threat. In the face of an almost complete absence of new antimicrobial drugs in development, antibiotic resistance (ABR) has become one of the main public health problems of our time. Antibiotics are a unique class of medications because of their potential societal impact; use of an antibiotic in a single patient can select for ABR that can spread to other people, animals, and the environment, making an antibacterial used in one patient ineffective for many others. Bacterial resistance can evolve rapidly. As bacteria acquire resistance mechanisms, the altered bacterial genetic material coding for resistance mechanisms can be transmitted at times readily between bacteria, broadening the reach and extent of resistance. Treatment failures because of multidrug resistant (MDR) bacteria, once rare, notable, and limited to hospitals, now occur very commonly in hospitals and increasingly in the community as well. It is estimated that at a minimum 25000 patients in Europe and 23000 in the USA die each year from infections caused by resistant bacteria. The cost of antibiotic resistance is tremendous, whether measured as the personal and societal burden of illness, death rates, or healthcare costs.

Although it is a never-ended phenomenon, antibiotic resistance is directly related to the volume of antibiotics used. We are using increasing amounts of antibiotics in health care and agriculture, and discharging these active drugs into the environment. The impact of widespread antibiotic use is enormous, promoting the development and dissemination of antimicrobial resistance.

Safeguarding antibiotics will require a concerted effort by citizens, patients and prescribers. The primary goal of WAAAR is to raise awareness about the urgency and magnitude of the threat and to promote an international dialogue to assist in effective responses. The Alliance, in particular through this declaration, is dedicated to actively promoting antibiotic preservation and to raising awareness among antibiotic prescribers, politicians and policy-makers, patient safety and advocacy groups, the pharmaceutical industry, international health organizations, and the general population. Individual actions, no matter how well intended, are doomed to failure unless there is an international dialogue, a common sense of purpose, and broad consensus on how best to proceed.

We must change how antibiotics are used and adopt proactive strategies, similar to those used to save endangered species. Preservation of the efficacy of antibiotics and to stabilization of antibiotic-susceptible bacterial ecosystems should be global goals.

We urge all of you to participate in this crusade, in your own field of interest. The medical miracle of antibiotic therapy must be protected – this is a global priority and our duty. Please, help us to act NOW, by supporting this declaration, to promote wiser use of antibiotics in animal and human health, and the necessary accompanying political actions to support better education, integrated surveillance for public health action, and research.

Promotion of awareness of all the stakeholders - including the general public - of the threat represented by antibiotic resistance

Strong cooperation among international political, economic and public health organizations, which, all together, must take the lead of this action against antibiotic resistance.

Organization, in each country, ideally by Ministries of Health or regulatory bodies, of a financed national plan for the containment of antibiotic resistance, with the participation of all stakeholders, including patient advocacy groups

Continuous access to antibiotics of assured quality, especially in middle and low income countries

Integrated Surveillance of antibiotic resistance (ABR) and antibiotic use Standardized monitoring of antibiotic use and resistance at institution, regional, and country (comprehensive national data instead) level (through a Centers for Diseases Control and Prevention model) to allow comparative statistics (benchmarking), to be updated preferably in real-time and at least every 12 months. This will require adequate laboratory capacity using international standardized methods that may be facilitated by a centralized technologic coordinating infrastructure and information technology

Use of diagnostic tests

Appropriate use of existing diagnostic tests and development and implementation of new rapid, cost-effective and accurate diagnostic tests, adapted to the local context, to aid in distinguishing bacterial and nonbacterial etiologies. Rapid diagnostics may help clinicians avoid unnecessary treatments, rapidly select appropriate targeted therapies and inform the duration of treatment

Antibiotic stewardship (prudent, controlled and monitored approaches to the use of antibiotics)

Development of large coordinated, effective information and awareness campaigns directed at the public on expectations about the rational/appropriate use of antibiotics.

Continuouseducation and training programs in the curriculum for all health care professionals in all settings (veterinarians, medical, dental, nursing, pharmacy and allied health care schools) and continuing professional education programs, on the rational use of antibiotics, including indications, dosing and duration of therapy. Education of farmers

Containment of bacterial transmission and prevention of infection

Promotion of universal hand hygiene and all infection control interventions that have been proven to reduce rates of resistance

Relentless efforts to prevent transmission of MDR organisms in healthcare, food production and animal husbandry

Programs to limit the contamination of drinking water with MDR bacteria, as well as contamination of the environment

Promotion of the use of available vaccines, in humans and animals

Basic and applied research, and development of new antibiotics

Increased support for basic and applied research aiming at curbing bacterial resistance in human and veterinary medicine.

Use of the principles of orphan drugs for new antibiotics

Incentives to stimulate research of new drugs (antibiotics and novel compounds) and vaccines via regulatory pathways that allow for fast track development.

New economic business models to support the cost of innovation while safeguarding public health interests.

Request for UNESCO to include the “concept of antibiotic” in the list of the intangible cultural heritage.

Our Alliance has several important strengths: A multidisciplinary and multi-professional structure including veterinary medicine, strong involvement of consumers, participation of several parliamentarians (deputies), global programmes including antibiotic stewardship, infection control, use of old and recent diagnostic tools, research, and upgrades of vaccination programmes, official support from many professional societies, from many different countries or various bodies.

ACTIONS IN 2015–2016

WAAAR has joined the network of international not-for-profit civil society organizations initiated by CDDEP (Center for Disease Dynamics, Economics, and Policy) and which will be launched on the occasion of the United Nations General Assembly, 21 September 2016 in New York City, Unites States.

WAAAR President Dr Jean Carlet will attend, as well as Garance Upham, Deputy Executive Secretary of WAAAR and member of Medicus Mundi International.

WAAAR IN FRANCE

Founded in Paris, ACdeBMR/WAAAR is the major player in France itself and in the French speaking world on antibiotic resistance issues.

Dr Carlet and the WAAAR team campaigned for decisive action, and in early 2015 Dr Carlet was selected to put together and chair France’s National Task Force on the Preservation of Antibiotics for 2015 relying on the many experts who are members of the WAAAR in the field of human and animal health, diagnostics and economics, patient safety and hospital- acquired infections.

A major event is being prepared as part of the November European Union weeks of mobilization on AMR.

WAAAR INTERNATIONALLY

WAAAR has many members and collaborators in French speaking Africa who lead actions on AMR, such as Dr Frank Mansour Adéoty in the Ivory Coast, former Minister of Health of Bénin, Dorothée Kinde Gazard, or retired (but ever active) Senegalese Colonel physician Babacar N’Doye whose top level international and national expertise in infection control was found very pertinent during the recent Ebola epidemic in Guinea Conakry.

After AMR Control 2015, here is AMR Control 2016, with participation from well known experts such as Lord Jim O’Neill from the United Kingdom Review on AMR, one of the major think tanks on AMR, Dr Awa Aidara Kane from the AGISAR WHO expert groups, and many more.

AMR Control 2015, published by Global Health Dynamics, has had a huge success. The book has been widely disseminated, in particular to agencies, like WHO, ECDC, CDC, the European Commission. A pre- 2016 edition has also been presented to high-level Ministers and DGS at the WHO Executive Board in January 2016 and at the United Nations World Health Assembly in May 2016.

AMR Control 2017 is being planned with many hot topics, including small and medium size companies innovations which may be very key to assist LMICs in this endeavour.

The AMR-Times Newsletter, Le Temps de la Résistance aux Antimicrobiens, is a new free monthly email newsletter available in French and in English, with a less frequent edition in Arabic. And, it is expected, soon in Spanish and Portuguese. It has over 1,500 direct subscribers and an estimated reach approaching 6,000 via scientific and professional networks who are re-distributing the newsletter among their own network. To receive AMR-Times : editor@amr-times.info.

A mostly volunteer and doctoral students young team manages this project with offshoots in Algeria, Egypt, Lebanon, The Netherlands, France, United Kingdom and Switzerland.

AMR-Times reports on leading scientific news on AMR, conferences and events. An e-Journal is under construction.

The 750 members of WAAAR are physicians, hospital managers, scientific researchers, hygiene nurses, patients and patient organizations, economists and concerned persons, from over 55 countries.

In June 2014, the WAAAR initiated the Paris Declaration which enlisted the support of over 100 persons and, up to 145 societies or institutes.

WAAAR is among the largest networks, along with REACT or APUA, of people actively working to make the world safe for human beings in the “post-antibiotic era”, a partner of the World Sepsis Day and a collaborator of COMBACTE.

Jean Carlet

MD, Founder and President

Vincent Jarlier

Vice-President

Garance Upham

Vice-President

Jean-Pierre Hermet

Treasurer

Joël Leroy

General Secretary

Our team

Far Too Often, Antibiotics Are Unnecessarily Prescribed for Common Respiratory Conditions in Outpatient Settings, Particularly in Urgent Care
A new study in The Journal of the American Medical Association: Internal Medicine found that healthcare professionals in outpatient settings often unnecessarily prescribed antibiotics for respiratory illnesses like the common cold and bronchitis, with prescribers in urgent care centers doing so nearly 46% of the time.
Other outpatient settings with high rates of unnecessary antibiotic prescriptions for these conditions include emergency departments (in 25% of visits), medical offices (in 17% of visits), and retail health clinics (in 14% of visits). Urgent care centers also had the highest percent of all visits that led to an antibiotic prescription.
Because this new study includes new data about unnecessary antibiotic prescribing in urgent care centers and retail health clinics, unnecessary antibiotic prescribing nationally in all outpatient settings may be higher than the estimated 30% reported in a 2016 study published in The Journal of the American Medical Association.
Efforts to improve antibiotic use could help reduce unnecessary antibiotic prescriptions in all outpatient settings, and are particularly important in urgent care centers. When antibiotics aren’t needed, they won’t help patients and the side effects could still hurt patients. Improving the way healthcare professionals prescribe antibiotics, and the way patients take antibiotics, helps keep us healthy now, helps fight antibiotic resistance, and ensures that life-saving antibiotics will be available for future generations.
To learn more about antibiotic prescribing and use, visit www.cdc.gov/antibiotic-use

Jean Carlet, President

Dear friends
I wish great vacations to both those of you who already left, and those who are impatient to leave. Please, find some informations on the international actions of WAAAR in the last few months ( sorry, I am a bit late).
We have been very active in France, in particular in the lobbying of the new french ministry of health, which seems far less motivated by the topic of AMR than the prior one. A project is aimed at informing the members of the parliament and the senate as well of the European parliament on the important public health problem represented by AMR. We have several scientific projects, in particular one on the influence of the relation between patients and HCP on antibiotic consumption. A more recent idea is to try to lobby the GPs, who still over-consume antibiotics in France ( and pharmaceutical drugs in general).
We have implemented many international actions in the last year. I want to thank warmly our vice-president Garance Upham, who have been very active and creative in the international actions of our NGO. WAAAR is now really considered as an important NGO in the field of AMR. We have regular contacts with WHO and OIE ( via Pr Acar). We have been asked rencently by the UN to participate to a IACG meeting in New York. We are one of the funders of CARA, which gathers many NGOs and scientific societies. With ESIC and ESCMID we created a european WG on AMR in european ICUs, called ANTARTICA. A large european prevalence study of AMR in ICU ( AURORA project) will start organized by Antartica.
We cooperate with several international ID societies in particular ICC and ISID.
The web site has been completely reniewed ( the prior one was a pity!).
The monthly newsletter ( AMR News) is considered by everybody as informative and easy to read. The yearly book, called AMR Control is also considered by many people as a real success. Those two activities have been entirely implemented by Garance. Again , many thanks to her. If you do not receive the Newsletter and/or if you want to receive AMR Control, please, be in touch with Garance Upham ( fannie.upham@gmail.com ).
We have in mind to organize an international meeting ( limited size) on some important issue. The topic is not yet decided. It could be "the fight against AMR in the community" which could be a way to motivate GPs on this issue ( they are very passive in France in this respect). We could imagine many other topics. The way to provide an appropriate usage of antibiotics to patients in, and outside the hospitals could be another important topic ( the consumption of AB is the main endpoint presently, although the most important one should be to treat the patients successfully). You are more than welcome to propose any topic for this meeting.
I wish all the best to all of you
Kindest regards
Jean

Jean Carlet, President

News from WAAAR

Dr Jean Carlet, Trained in internal medicine, was head of the ICU in Hospital St Joseph in Paris for 25 years and has published in medical journals on the issue of antibiotic resistance for over 30 years. ACdeBMR WAAAR initially gained international recognition with the launch of the Paris Declaration. In 2015 he was nominated by France’s minister of health as the president of a Special Task Force for Antibiotic Preservation to elaborate the national plan on AMR. Dr Carlet is a leading steering committee member of several coalitions to combat AMR, such as the CDDEP’s CARA Coalition : The Conscience of Antimicrobial Resistance Accountabiliy. In November of 2017, he initiated the launch of ANTARTICA, The ANTimicrobiAl Resistance CriTIcal Care, a new coalition on scepsis, to achieve the WHO target, along with like minded specialist physicians in critical care. Along with WAAAR’s Vice-President Garance F Upham, Dr Carlet is Editor-in-Chief of the leading AMR publication for investors and decision makers : AMR Control, in collaboration with London publisher Global Health Dynamics. www.amrcontrol.info

Jean CARLET

President and Founder of ACdeBMR / WAAAR

Dr Vincent Jarlier, MD, is a long standing member of ACdeBMR/WAAAR and today its Vice-President. He has many years as a researcher and practitioner in France and the USA, notably on antibiotic resistance, hospital acquired infections with a focus on preventing the transmission of AMR infections in health care. He is a Member of the Management of the European System for the Surveillance of Antibiotics, (EARS-Net, ECDC), of the Advisory board of the European Committee on Infection Control (EUCIC), of the European Society (ESCMID), and a leader in the French National Committee on Nosocomial Infections, as well as the Delegate for Hospital Acquired Infections for the national health system, and in charge of the BMR_Raisin program for surveillance of AMR infections. He is a founder of the ONERBA, the National Observatory on Antibiotic Resistance.
Dr Jarlier has been author and co-author to over 350 publications.

Vincent JARLIER

Vice President

Dr Joël Leroy, MD, infectious disease physician in the University-Hospital (CHU) of Besançon, France since 1987 has been involved in promoting stewardship of antibiotic use and prescription. He works with hospital doctors in his region and beyond to optimize antibiotic use, reduce bacterial resistance and to promote vaccination. Those activities are conducted as part of a broader program which he leads since its creation in 2008, PRIMAIR (Regional interdisciplinary Program to Master Infections and Bacterial Resistance). PRIMAIR is integrated in the regional support program for the prevention of hospital acquired infections (CPIAs, Bourgogne Franche-Comté). The WAAAR alliance has a similar purpose and Dr Leroy participated in the launch. He is now WAAAR's General Secretary.

Joël LEROY

Secretary

Jean-Pierre Hermet is Chairman of the Supervisory Board of DIAXONHIT, a leading French manufacturer of in vitro diagnostic products, with sales over 50 M€ listed on Euronext. Since 2015, he has been a member of the Strategic Committee of NOVOLYZE, a food security company.
Since 2016, he has coached winners of the 2020 Horizon program of the European agency EASME. In 1999, he founded Hemosystem, which developed a method to rapidly detect bacteria in blood and blood products.
He is also author of several studies published by Les Echos-Eurostaf.

Jean-Pierre HERMET

Treasurer of ACdeBMR/WAAAR since its inception

Garance is today Vice-President of the World Alliance Against Antibiotic Resistance (WAAAR), winner 3rd Prize in the global NGO competition on AMR by the EU. Together with Dr Jean Carlet, she is editor in chief of the prestigious yearly "AMR Control" with contributions from many MoH (Algeria, China, France, Germany, Lebanon, Senegal, USA, the World Bank, USAID, or BARDA www.amrcontrol.info. She has 30 years experience in advocacy for IPC, having worked in infection control in Africa, then ten years as Patients for Patients Safety WHO expert.

Garance UPHAM

Vice-President

Contact us

To find out more information on the benefits of membership contact presidence@waaar.org